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Abstract: FR-PO184

Hyperphosphatemia as Initial Presentation of Multiple Myeloma

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Bonilla, Marco A., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Pariswala, Tanazul T., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Ali, Mahmoud, Saint Barnabas Hospital, Bronx, New York, United States
  • Corona, Antonio, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Introduction

Hyperphosphatemia is commonly seen in patients with kidney failure.However, in patients with normal kidney function, it can be a clue to underlying dysproteinemia

Case Description

A 71-year-old male with a medical history of anemia presented for evaluation of abdominal pain. On presentation vital signs were unremarkable. A physical exam revealed a thin elderly male with temporal wasting.Laboratory evaluation showed hemoglobin of 7.1g/dl, sodium 133mmol/L, K 4.2mmol/L, creatinine 1.4mg/dl, Calcium 8.7mg/dl, albumin 3.3g/dl, total protein 10.3g/dl, Gamma GAP 7g/dl, phosphorus 17.7mg/dl. Further workup is in table1.

Discussion

Our case describes an unusual initial presentation of MM in a patient with severe hyperphosphatemia. Bone marrow biopsy reported plasma cell myeloma with 70% CD138-positive plasma cells, confirming a diagnosis of IgG-kappa-type MM. Spurious electrolyte abnormalities present a challenge for clinicians, pseudo-hyperphosphatemia in patients with MM has been associated with laboratory artifacts. A serum sample from a patient with MM will cause an increase in serum turbidity and its optical density, leading to falsely elevated phosphate levels.

After the diagnosis of MM, hyperphosphatemia was attributed to spurious etiology. He started IV corticosteroids for 4 days, with a striking improvement in the phosphorus level(Figure1). Interventions to lower serum phosphorous in this setting should be avoided if there are normal calcium and kidney function levels. Physicians should be aware that an unexplained hyperphosphatemia might be a diagnostic clue for a paraprotein disease.

Table 1. Further laboratory data
LaboratoryValueReference
IFE kappa68.56 mg/dl0.33-1.94 mg/dl
IFE lambda0.39 mg/dl0.57-2.63 mg/dl
Kappa/lambda ratio175.79 mg/dl0.26-1.65 mg/dl
Quantitative IgG4175 mg/dl700-1600 mg/dl
Serum protein Electrophoresis M-spike3.9 g/dl 
Serum ImmunofixationIgG and Kappa bands.